BACKGROUND Retroperitoneal lymph node dissection(RPLND)plays a diagnostic,therapeutic,and prognostic role in myriad urologic malignancies,including testicular carcinoma,renal cell carcinoma(RCC),and upper urinary trac...BACKGROUND Retroperitoneal lymph node dissection(RPLND)plays a diagnostic,therapeutic,and prognostic role in myriad urologic malignancies,including testicular carcinoma,renal cell carcinoma(RCC),and upper urinary tract urothelial carcinoma.RCC represents 2%of all cancers with approximately 25%of patients presenting with advanced disease.Clear cell RCC(CCRCC)is the most common RCC,accounting for 75%-80%of all RCC.CASE SUMMARY A 71-year-old man presented with a history of benign prostatic hypertrophy.He was asymptomatic without any hematuria,pain,or other urinary symptoms.A computed tomography(CT)scan of the abdomen and pelvis showed a 1.8 cm left retroperitoneal lymph node.There was no evidence of renal pathology.A core biopsy was performed of the left para-aortic lymph node.Although the primary tumor site was unknown,the morphological and immunohistochemical features were most consistent with CCRCC.A RPLND was performed which revealed a single mass 5.5 cm in greatest dimension with extensive necrosis.The retroperitoneal lymph node was most compatible with CCRCC.A nephrectomy was not conducted as a renal mass had not been detected on any prior imaging studies.The patient did not receive any type of adjuvant therapy.The patient underwent surveillance with serial CT scans with contrast of the chest,abdomen,and pelvis for the next 5 years,all of which demonstrated no recurrent or metastatic disease and no evidence of retroperitoneal adenopathy.CONCLUSION Our unique case emphasizes the therapeutic role of metastasectomy in metastatic CCRCC even in the absence of primary tumor in the kidneys.展开更多
Primary liver cell carcinoma (PLCC) or Hepatocellular carcinoma (HCC) is the most common primary malignant liver tumor in Nigeria. It is a difficult problem in surgery for the diagnosis and therapy of spontaneous live...Primary liver cell carcinoma (PLCC) or Hepatocellular carcinoma (HCC) is the most common primary malignant liver tumor in Nigeria. It is a difficult problem in surgery for the diagnosis and therapy of spontaneous liver rupture. The clinical presentation can be varied owing to its clinical signs being usually not specific; therefore, correct diagnosis and management are very important. Without any treatment, the outcome is poor and survival rate is only 10%. Surgeons operate on those patients who present with ruptured PLCC; consisting of packing, hepatic artery ligation and hepatectomy. However, it is often associated with a high mortality rate; as high as 70%, even for the less invasive procedures like packing, argon beam coagulation or hepatic artery ligation. We present a 24-year old lady who had ligation of hepatic artery at an emergency laparotomy for ruptured primary liver cell carcinoma.展开更多
In the last years,several studies have been focused on elucidate the role of tumor microenvironment(TME)in cancer development and progression.Within TME,cells from adaptive and innate immune system are one of the main...In the last years,several studies have been focused on elucidate the role of tumor microenvironment(TME)in cancer development and progression.Within TME,cells from adaptive and innate immune system are one of the main abundant components.The dynamic interactions between immune and cancer cells lead to the activation of complex molecular mechanisms that sustain tumor growth.This important cross-talk has been elucidate for several kind of tumors and occurs also in patients with liver cancer,such as hepatocellular carcinoma(HCC)and intrahepatic cholangiocarcinoma(iCCA).Liver is well-known to be an important immunological organ with unique microenvironment.Here,in normal conditions,the rich immune-infiltrating cells cooperate with non-parenchymal cells,such as liver sinusoidal endothelial cells and Kupffer cells,favoring self-tolerance against gut antigens.The presence of underling liver immunosuppressive microenvironment highlights the importance to dissect the interaction between HCC and iCCA cells with immune infiltrating cells,in order to understand how this cross-talk promotes tumor growth.Deeper attention is,in fact,focused on immune-based therapy for these tumors,as promising approach to counteract the intrinsic anti-tumor activity of this microenvironment.In this review,we will examine the key pathways underlying TME cell-cell communications,with deeper focus on the role of natural killer cells in primary liver tumors,such as HCC and iCCA,as new opportunities for immune-based therapeutic strategies.展开更多
A 66-year-old woman presented with a 2-year history of asthma has progression of dyspnea within a week, and a computed tomography (CT) revealed an endotracheal tumor at level of aortic arch. The resected tumor, measur...A 66-year-old woman presented with a 2-year history of asthma has progression of dyspnea within a week, and a computed tomography (CT) revealed an endotracheal tumor at level of aortic arch. The resected tumor, measured by 18 × 12 × 10 mm, has histologically malignant features including frank invasion with desmoplastic stroma and foci of necrosis. Presence of glycogen and mucin was confirmed by periodic acid-Schiff (PAS) and diastase PAS staining. Immunohistochemically, the tumor cells were diffusely positive for cytokeratin (CK) 7 and AE1/3, focally positive for CK5/6 and CK14, but negative for CK20. Thyroid transcription factor-1 (TTF-1), Napsin A, and SP-A, indicating lung parenchymal origin were all negative. Other muscular markers, neuroendocrine markers, renal cell carcinoma markers, and markers related to perivascular epithelioid cell tumors were all negative. Postoperative systemic examination suggests no primary tumor outside the lung. The follow up was excellent being recurrence free for 14 months in spite of the positive surgical margin by the tumor cells. This is a first report ?of rare neoplasm, clear cell carcinoma of salivary gland type, presenting as an endotracheal mass.展开更多
Background:Distinguishing between primary clear cell carcinoma of the liver(PCCCL)and common hepatocellular carcinoma(CHCC)through traditional inspection methods before the operation is difficult.This study aimed to e...Background:Distinguishing between primary clear cell carcinoma of the liver(PCCCL)and common hepatocellular carcinoma(CHCC)through traditional inspection methods before the operation is difficult.This study aimed to establish a Faster region-based convolutional neural network(RCNN)model for the accurate differential diagnosis of PCCCL and CHCC.Methods:In this study,we collected the data of 62 patients with PCCCL and 1079 patients with CHCC in Beijing YouAn Hospital from June 2012 to May 2020.A total of 109 patients with CHCC and 42 patients with PCCCL were randomly divided into the training validation set and the test set in a ratio of 4:1.The Faster RCNN was used for deep learning of patients’data in the training validation set,and established a convolutional neural network model to distinguish PCCCL and CHCC.The accuracy,average precision,and the recall of the model for diagnosing PCCCL and CHCC were used to evaluate the detection performance of the Faster RCNN algorithm.Results:A total of 4392 images of 121 patients(1032 images of 33 patients with PCCCL and 3360 images of 88 patients with CHCC)were uesd in test set for deep learning and establishing the model,and 1072 images of 30 patients(320 images of nine patients with PCCCL and 752 images of 21 patients with CHCC)were used to test the model.The accuracy of the model for accurately diagnosing PCCCL and CHCC was 0.962(95%confidence interval[CI]:0.931-0.992).The average precision of the model for diagnosing PCCCL was 0.908(95%CI:0.823-0.993)and that for diagnosing CHCC was 0.907(95%CI:0.823-0.993).The recall of the model for diagnosing PCCCL was 0.951(95%CI:0.916-0.985)and that for diagnosing CHCC was 0.960(95%CI:0.854-0.962).The time to make a diagnosis using the model took an average of 4 s for each patient.Conclusion:The Faster RCNN model can accurately distinguish PCCCL and CHCC.This model could be important for clinicians to make appropriate treatment plans for patients with PCCCL or CHCC.展开更多
Immune checkpoint inhibitors(ICIs)like programmed cell death-1(PD-1)/programmed death-ligand 1(PD-L1)inhibitor have shown considerable efficacy in several important cancers including primary liver cancer(PLC)like hepa...Immune checkpoint inhibitors(ICIs)like programmed cell death-1(PD-1)/programmed death-ligand 1(PD-L1)inhibitor have shown considerable efficacy in several important cancers including primary liver cancer(PLC)like hepatocellular carcinoma and cholangiocarcinoma.However,only some patients with PLC will benefit,so combination therapy and biomarker classification detected by next-generation sequencing or immunohistochemistry are very important.Herein,we briefly summarize ICI-based therapies and stratify these evolving therapies for advanced PLC into three stages of immunotherapies Mark(Mk.)1.0,2.0,and 3.0.We illustrated the significance of ICI monotherapy(Mk.1.0),offering combinational approaches with traditional strategies(Mk.2.0)and additional locoregional therapy(Mk.3.0)to achieve longer survival and even meet the“No Evidence of Disease”status.We also highlight the importance of biomarkers and prognostic factors for patients with advanced PLC treated with ICI-based therapies.Multidisci-plinary team management should be investigated and collaborated closely to manage adverse events and sequential therapy suggestions for patients.展开更多
文摘BACKGROUND Retroperitoneal lymph node dissection(RPLND)plays a diagnostic,therapeutic,and prognostic role in myriad urologic malignancies,including testicular carcinoma,renal cell carcinoma(RCC),and upper urinary tract urothelial carcinoma.RCC represents 2%of all cancers with approximately 25%of patients presenting with advanced disease.Clear cell RCC(CCRCC)is the most common RCC,accounting for 75%-80%of all RCC.CASE SUMMARY A 71-year-old man presented with a history of benign prostatic hypertrophy.He was asymptomatic without any hematuria,pain,or other urinary symptoms.A computed tomography(CT)scan of the abdomen and pelvis showed a 1.8 cm left retroperitoneal lymph node.There was no evidence of renal pathology.A core biopsy was performed of the left para-aortic lymph node.Although the primary tumor site was unknown,the morphological and immunohistochemical features were most consistent with CCRCC.A RPLND was performed which revealed a single mass 5.5 cm in greatest dimension with extensive necrosis.The retroperitoneal lymph node was most compatible with CCRCC.A nephrectomy was not conducted as a renal mass had not been detected on any prior imaging studies.The patient did not receive any type of adjuvant therapy.The patient underwent surveillance with serial CT scans with contrast of the chest,abdomen,and pelvis for the next 5 years,all of which demonstrated no recurrent or metastatic disease and no evidence of retroperitoneal adenopathy.CONCLUSION Our unique case emphasizes the therapeutic role of metastasectomy in metastatic CCRCC even in the absence of primary tumor in the kidneys.
文摘Primary liver cell carcinoma (PLCC) or Hepatocellular carcinoma (HCC) is the most common primary malignant liver tumor in Nigeria. It is a difficult problem in surgery for the diagnosis and therapy of spontaneous liver rupture. The clinical presentation can be varied owing to its clinical signs being usually not specific; therefore, correct diagnosis and management are very important. Without any treatment, the outcome is poor and survival rate is only 10%. Surgeons operate on those patients who present with ruptured PLCC; consisting of packing, hepatic artery ligation and hepatectomy. However, it is often associated with a high mortality rate; as high as 70%, even for the less invasive procedures like packing, argon beam coagulation or hepatic artery ligation. We present a 24-year old lady who had ligation of hepatic artery at an emergency laparotomy for ruptured primary liver cell carcinoma.
文摘In the last years,several studies have been focused on elucidate the role of tumor microenvironment(TME)in cancer development and progression.Within TME,cells from adaptive and innate immune system are one of the main abundant components.The dynamic interactions between immune and cancer cells lead to the activation of complex molecular mechanisms that sustain tumor growth.This important cross-talk has been elucidate for several kind of tumors and occurs also in patients with liver cancer,such as hepatocellular carcinoma(HCC)and intrahepatic cholangiocarcinoma(iCCA).Liver is well-known to be an important immunological organ with unique microenvironment.Here,in normal conditions,the rich immune-infiltrating cells cooperate with non-parenchymal cells,such as liver sinusoidal endothelial cells and Kupffer cells,favoring self-tolerance against gut antigens.The presence of underling liver immunosuppressive microenvironment highlights the importance to dissect the interaction between HCC and iCCA cells with immune infiltrating cells,in order to understand how this cross-talk promotes tumor growth.Deeper attention is,in fact,focused on immune-based therapy for these tumors,as promising approach to counteract the intrinsic anti-tumor activity of this microenvironment.In this review,we will examine the key pathways underlying TME cell-cell communications,with deeper focus on the role of natural killer cells in primary liver tumors,such as HCC and iCCA,as new opportunities for immune-based therapeutic strategies.
文摘A 66-year-old woman presented with a 2-year history of asthma has progression of dyspnea within a week, and a computed tomography (CT) revealed an endotracheal tumor at level of aortic arch. The resected tumor, measured by 18 × 12 × 10 mm, has histologically malignant features including frank invasion with desmoplastic stroma and foci of necrosis. Presence of glycogen and mucin was confirmed by periodic acid-Schiff (PAS) and diastase PAS staining. Immunohistochemically, the tumor cells were diffusely positive for cytokeratin (CK) 7 and AE1/3, focally positive for CK5/6 and CK14, but negative for CK20. Thyroid transcription factor-1 (TTF-1), Napsin A, and SP-A, indicating lung parenchymal origin were all negative. Other muscular markers, neuroendocrine markers, renal cell carcinoma markers, and markers related to perivascular epithelioid cell tumors were all negative. Postoperative systemic examination suggests no primary tumor outside the lung. The follow up was excellent being recurrence free for 14 months in spite of the positive surgical margin by the tumor cells. This is a first report ?of rare neoplasm, clear cell carcinoma of salivary gland type, presenting as an endotracheal mass.
文摘Background:Distinguishing between primary clear cell carcinoma of the liver(PCCCL)and common hepatocellular carcinoma(CHCC)through traditional inspection methods before the operation is difficult.This study aimed to establish a Faster region-based convolutional neural network(RCNN)model for the accurate differential diagnosis of PCCCL and CHCC.Methods:In this study,we collected the data of 62 patients with PCCCL and 1079 patients with CHCC in Beijing YouAn Hospital from June 2012 to May 2020.A total of 109 patients with CHCC and 42 patients with PCCCL were randomly divided into the training validation set and the test set in a ratio of 4:1.The Faster RCNN was used for deep learning of patients’data in the training validation set,and established a convolutional neural network model to distinguish PCCCL and CHCC.The accuracy,average precision,and the recall of the model for diagnosing PCCCL and CHCC were used to evaluate the detection performance of the Faster RCNN algorithm.Results:A total of 4392 images of 121 patients(1032 images of 33 patients with PCCCL and 3360 images of 88 patients with CHCC)were uesd in test set for deep learning and establishing the model,and 1072 images of 30 patients(320 images of nine patients with PCCCL and 752 images of 21 patients with CHCC)were used to test the model.The accuracy of the model for accurately diagnosing PCCCL and CHCC was 0.962(95%confidence interval[CI]:0.931-0.992).The average precision of the model for diagnosing PCCCL was 0.908(95%CI:0.823-0.993)and that for diagnosing CHCC was 0.907(95%CI:0.823-0.993).The recall of the model for diagnosing PCCCL was 0.951(95%CI:0.916-0.985)and that for diagnosing CHCC was 0.960(95%CI:0.854-0.962).The time to make a diagnosis using the model took an average of 4 s for each patient.Conclusion:The Faster RCNN model can accurately distinguish PCCCL and CHCC.This model could be important for clinicians to make appropriate treatment plans for patients with PCCCL or CHCC.
基金supported by National High Level Hospital Clinical Research Funding[2022-PUMCH-B-128],CAMS Innovation Fund for Medical Sciences(CIFMS)[2022-I2M-C&T-A-003][2021-I2M-1-061][2021-I2M-1-003]CSCO-hengrui Cancer Research Fund[Y-HR2019-0239][Y-HR2020MS-0415][Y-HR2020QN-0414]CSCO-MSD Cancer Research Fund[Y-MSDZD2021-0213]and National Ten-Thousand Talent Program.
文摘Immune checkpoint inhibitors(ICIs)like programmed cell death-1(PD-1)/programmed death-ligand 1(PD-L1)inhibitor have shown considerable efficacy in several important cancers including primary liver cancer(PLC)like hepatocellular carcinoma and cholangiocarcinoma.However,only some patients with PLC will benefit,so combination therapy and biomarker classification detected by next-generation sequencing or immunohistochemistry are very important.Herein,we briefly summarize ICI-based therapies and stratify these evolving therapies for advanced PLC into three stages of immunotherapies Mark(Mk.)1.0,2.0,and 3.0.We illustrated the significance of ICI monotherapy(Mk.1.0),offering combinational approaches with traditional strategies(Mk.2.0)and additional locoregional therapy(Mk.3.0)to achieve longer survival and even meet the“No Evidence of Disease”status.We also highlight the importance of biomarkers and prognostic factors for patients with advanced PLC treated with ICI-based therapies.Multidisci-plinary team management should be investigated and collaborated closely to manage adverse events and sequential therapy suggestions for patients.
