Characterization of focal hypermetabolic thyroid incidentaloma: An analysis with F-18 fluorodeoxyglucose positron emission tomography/computed tomography parameters

BACKGROUND Incidentally found thyroid tumor(thyroid incidentaloma,TI)on F-18 fluorodeoxyglucose(FDG)positron emission tomography-computed tomography(PETCT)is reported in 2.5%-5%of patients being investigated for non-thyroid purposes.Up to 50%of these cases have been diagnosed to be malignant by cytological/histological results.Ultrasonography(US)and fine-needle aspiration cytology are recommended for thyroid nodules with high FDG uptake(hypermetabolism)that are 1 cm or greater in size.It is important to accurately determine whether a suspicious hypermetabolic TI is malignant or benign.AIM To distinguish malignant hypermetabolic TIs from benign disease by analyzing F-18 FDG PET-CT parameters and to identify a cut-off value.METHODS Totally,12761 images of patients who underwent F-18 FDG PET-CT for nonthyroid purposes at our hospital between January 2016 and December 2020 were retrospectively reviewed,and 339 patients[185 men(mean age:68±11.2)and 154 women(mean age:63±15.0)]were found to have abnormal,either focal or diffuse,thyroid FDG uptake.After a thorough review of their medical records,US,and cytological/histological reports,46 eligible patients with focal hypermetabolic TI were included in this study.The TIs were categorized as malignant and benign according to the cytological/histological reports,and four PET parameters[standardized uptake value(SUV)max,SUV_(peak),SUV_(mean),and metabolic tumor volume(MTV)]were measured on FDG PET-CT.Total lesion glycolysis(TLG)was calculated by multiplying the SUV_(mean) by MTV.Both parametric and non-parametric methods were used to compare the five parameters between malignant and benign lesions.Receiver operating characteristic(ROC)curve analysis was performed to identify a cut-off value.RESULTS Each of the 46 patients[12 men(26.1%;mean age:62±13.1 years)and 34 women(73.9%;mean age:60±12.0 years)]with focal hypermetabolic TIs had one focal hypermetabolic TI.Among them,26(56.5%)were malignant and 20(43.5%)were benign.SUV_(max),SUV_(peak),SUV_(mean),and TLG were all higher in malignant lesions than benign ones,but the difference was statistically significant(P=0.012)only for SUV_(max).There was a positive linear correlation(r=0.339)between SUV_(max) and the diagnosis of malignancy.ROC curve analysis for SUV_(max) revealed an area under the curve of 0.702(P<0.05,95%confidence interval:0.550-0.855)and SUV_(max) cut-off of 8.5 with a sensitivity of 0.615 and a specificity of 0.789.CONCLUSION More than half of focal hypermetabolic TIs on F-18 FDG PET-CT were revealed as malignant lesions,and SUV_(max) was the best parameter for discriminating between malignant and benign disease.Unexpected focal hypermetabolic TIs with the SUV_(max) above the cut-off value of 8.5 may have a greater than 70%chance of malignancy;therefore,further active assessment is required.

Changing trends and influencing factors of the quality of life of chemotherapy patients with breast cancer

Objective： To understand the changing trajectory of quality of life（QOL） during the treatment courses of breast cancer patients during chemotherapy and to investigate the factors in each treatment course that affect QOL.Methods： The M.D. Anderson Symptom Inventory Scale, the Hospital Anxiety and Depression Scale（HADS）, and the Functional Assessment of Cancer Therapy-Breast（FACT-B） scale were used to perform a survey on 174 breast cancer patients who received the TAC（docetaxel, Adriamycin, and cyclophosphamide） chemotherapy regimen before postoperative chemotherapy and 5-7 days after each chemotherapy course.Results： The QOL scores of the breast cancer patients were the lowest before the postoperative chemotherapy（81.2 ± 19.6） and the highest after the second chemotherapy course（94.5 ± 14.4）. After the fourth and fifth chemotherapy courses, the scores were much lower again, with values of 82.7 ± 13.9and 82.6 ± 13.1, respectively. The scores improved again after the sixth chemotherapy course（93.9 ± 18.7）. Furthermore, each treatment course had different related symptoms that affected the QOL of the patients.Conclusions： More attention should be paid to the changing trajectory of QOL of patients in all treatment courses and to the influence of treatment-related symptoms on the QOL of patients; moreover, interventions should be adopted by medical care personnel to increase QOL in cancer patients.

Low-grade chondrosarcoma of the larynx: A case report

BACKGROUND Chondrosarcomas of the larynx are malignant tumours that most commonly originate from the hyaline cartilage.Chondrosarcoma of the larynx,the most common type of low-grade tumour,accounts for 1%of all laryngeal neoplasms.CASE SUMMARY We present the case of a 60-year-old female patient who developed progressive hoarseness and shortness of breath over a 2-mo period.The patient had undergone resection of a laryngeal tumour 14 years before the aforementioned symptoms occurred,and histopathological analysis indicated that it was a chondroma.During the assessment of the patient,a submucosal,oval-shaped tumour was detected that was predominantly located on the left side of the larynx and was approximately 6 cm in size.The decision to perform left partial vertical laryngectomy was made.A pathohistological diagnosis of low-grade chondrosarcoma was made.Considering the results of pathohistological analysis and the positive margins of the resection,a total laryngectomy was performed.During the 12-mo follow-up,no local relapse or regional or distant metastases was detected.CONCLUSION Chondrosarcoma of the larynx must be considered in the differential diagnosis of laryngeal submucosal tumours.It is crucial to carefully sample of tumour tissue,differentiate chondroma and chondrosarcoma,and consider the possibility of malignant changes from chondroma to chondrosarcoma.

The Number of Lymph Nodes and Relationship with Presence of Thyroiditis and Thymic Tissue in the Central Neck Dissection Materials for Thyroid Papillary Carcinoma: Pathologic Analysis

Background: Central lymph node dissection (CLND) for papillary thyroid carcinoma (PTC) allows correct pathologic staging of lymph nodes and planning of postoperative management. The purpose of this study was to determine the number of the lymph nodes in the CLND and the relationship to presence of chronic lymphocytic thyroiditis (CLT) and thymic tissue (TT). Methods: Total thyroidectomy and CLND materials from 153 patients with PTC were included in this study. Two histopathologic features (presence of CLT and TT) were evaluated for their value in adequacy of CLND. Results: Histopathologic examination revealed CLT and TT in CLND materials in 70 (46%) and 63 (41%) patients, respectively. Total number of lymph nodes in CLND materials was significantly higher in CLT (+) and TT (+) groups (p Conclusions: Our study demonstrates that presence of CLT in thyroid gland has been associated with higher number of central lymph nodes mainly due to increased number of benign hyperplastic lymph nodes. It may be possible to conclude that upper limit of lymph nodes for satisfactory CLND would be higher to correctly evaluate central lymph node status in existing staging systems if specimens have CLT. Results of this study also show that the presence of TT in surgical materials may represent the adequacy of CLND.

WWOX suppresses KLF5 expression and breast cancer cell growth

The WW domain-containing oxidoreductase（WWOX） is a tumor suppressor in a variety of cancers, including breast cancer. Reduced WWOX expression is associated with the basal-like subtype and a relatively poor disease-free survival rate among breast cancer patients. Though several WWOX partners have been identified, the functional mechanisms of WWOX＇s role in cancers have not been fully addressed to date. In the current study, we found WWOX suppresses expression of KLF5—an oncogenic transcription factor—at protein level, and suppresses cancer cell proliferation in both bladder and breast cancer cell lines. Furthermore, we demonstrated that WWOX physically interacts with KLF5 via the former＇s WW domains and the latter＇s PY motifs. Interestingly, we found the expression of WWOX negatively correlates with KLF5 expression in a panel of breast cancer cell lines. Taken together, we conjecture that WWOX may suppress cancer cell proliferation partially by reducing the expression of KLF5.

Skin cancer in immunosuppressed transplant patients: Vigilance matters

Liver transplantation(LT) is a widely-accepted, definitive therapy of irreversible liver diseases including hepatitis C, alcoholic liver disease and metabolic liver disease. After transplantation, patients generally use a variety of immunosuppressive medications for the rest of their lives to prevent rejection of transplanted liver. Mortality after LT is mainly caused by recurrence of alcoholic hepatitis which is mostly seen in the patients who resume heavy drinking. On the other hand, de-novo malignancies after LT are not seldom. Skin cancers make up 13.5% of the de-novo malignancies seen in these patients. Malignancies tend to affect survival earlier in the course with a 53% risk of death at 5 years after diagnosis. We aimed to report a case who underwent LT secondary to alcoholic liver disease and developed squamous cell carcinoma of the skin eighteen years after transplantation. In summary, transplant recipients are recommended to be educated on self examination for skin cancer; health care providers should be further suspicious during routine dermatological examinations of the transplant patients and biopsies of possible lesions for skin cancer is warranted even many years after transplantation.

Comparison of hyaluronidase expression, invasiveness and tubule formation promotion in ER （-） and ER （＋） breast cancer cell lines in vitro

Background Hyaluronidase （Hyase） is an enzyme which hydrolyses hyaluronan （HA）, a large nonsulfated glycosaminoglycan. Several genes have been identified to code for hyaluronidases in humans. Its role has only recently been underlined in the invasion of prostate cancer, colonic cancer, and breast cancer. Moreover, the findings were in agreement with some experimental results which showed that HA-derived oligosaccharides had angiogenesis-promoting activity. All these findings prompted us to investigate factors that had been characterized as putative invasive factors in different human breast cancer-derived cell lines. Methods We selected two series of human breast cancer-derived cell lines whose expression of estrogen receptors （ER） was previously published. Hyaluronidase secretion in culture medium and expression of matrix metallo-proteinase （MMP）-9, cathepsin-D （cath-D） and vascular endothelial growth factor （VEGF） by cells were determined. We also investigated cell invasiveness in the Matrigel invasion assay, and studied the capability of cancer cells to promote in vitro formation of tubules by endothelial cells. Results ER（-） cells secreted significantly more hyaluronidase （P 〈0.001） and expressed significantly more VEGF （P 〈0.01）, MMP-9 （P 〈0.05） and cath-D （P 〈0.0001） than ER（＋） cells. Invasion through Matrigel by ER（-） Hyase（＋） cells was significantly higher than that by ER（＋） Hyase（-） cells （P 〈0.05）. In both cases, invasion was decreased by heparin （P 〈0.05）. When ECV-304 endothelial cells were co-cultivated in millicell chambers with cancer cells, ECV-304 cells were induced to form tubules. Tubule formation was demonstrated to be more prominent with ER（-） Hyase（＋） cells than with ER（＋） Hyase（-） cells （P 〈0.05）. Conclusion Invasive features of ER（-） breast cancer cells can be characterized in vitro by an invasive Matrigel assay, as the induction of tubule formation by ECV-304 endothelial cells, higher secretion of hyaluronidase, and higher expression of proteinases MMP-9, cath-D, and the angiogenesis promoting factor VEGF.

Role of thermal ablation in the management of colorectal liver metastasis

With a recent randomized prospective trial revealing that thermal ablative therapy as local tumor control improved overall survival (OS) in patients with unresectable colorectal cancer liver metastases (CRLM), thermal ablation continues to remain as an important treatment option in this patient population. Our aim of this article is to review the current role of the ablative therapy in the management of CRLM patients. Main indications for thermal ablation include (Ⅰ) unresectable liver lesions;(Ⅱ) in combination with hepatectomy;(Ⅲ) in patients with significant medical comorbidities or poor performance status (PS);(Ⅳ) a small (<3 cm) solitary lesion, which would otherwise necessitate a major liver resection;and (Ⅴ) patient preference. There are several approaches and modalities for ablative therapy, including open, percutaneous, and laparoscopic approaches, as well as radiofrequency ablation (RFA) and microwave ablation (MWA). Each approach and ablation modality have its own pros and cons. Percutaneous and laparoscopic approaches are preferred due to minimally invasive nature, yet laparoscopic approach has more benefits from thorough intraoperative ultrasound (US) exam as well as complete peritoneal staging with laparoscopy. Similarly, whereas high local tumor failure rate has been a major concern with RFA, MWA or microwave thermosphere ablation (MTA) have demonstrated significantly improved local tumor control due to homogenous tissue heating, ability to reach higher tissue temperatures, and less susceptible to the "heat-sink" effect. Although liver resection is the standard of care for CRLM, there have been some retrospective studies demonstrating similar oncological outcome between ablative therapy and surgical resection in very selected populations with small (<3 cm) solitary CRLM. Lastly, ablative therapy and liver resection should not be mutually exclusive, especially in the management of bilobar liver metastases. Concomitant ablative therapy with hepatectomy may spare the patients from having two-stage hepatectomy with less morbidity. The role of the thermal ablation will continue to evolve in patients with resectable and ablatable lesions owing to newly emerging technology, in addition to new systemic treatment options, including immunotherapy for metastatic colorectal cancer (CRC). Keywords: Thermal ablation;radiofrequency ablation (RFA);microwave ablation (MWA);colorectal cancer liver metastasis (CRLM)

Navigating emotional challenges:A journey with patients undergoing chemotherapy

A recent article reported that cancer patients with subthreshold depression are more likely to develop major depression within a year.Multivariate regression analysis revealed that regular exercise was a protective factor against cancerrelated fatigue,whereas advanced age,radiotherapy,pain,and low hemoglobin were risk factors for cancer-related fatigue.A limitation of this study was the lack of methodological details about leukemia patients receiving depressive treatment at a specific hospital.Professional assessment,behavioral modification plans,communication,destressing techniques,and educational plans may help chemotherapy patients manage emotional issues and reduce anxiety.Furthermore,these strategies can inspire patients to create,facilitate their treatment,and help them to remain healthy.

宽角“V”型是经右内颈静脉置管建立中心静脉通道时TIVAD导管的理想摆放形态

Introduction A TIVAD(totally implantable venous access device)catheter is inserted into one of the large veins,usually the superior vena cava(SVC),to gain permanent central venous access.The tip of the catheter sits just above the heart in the distal third of the SVC and the other end is attached to the silicon rubber port that sits underneath the skin of the anterior chest wall fixed to the fascia of the pectoralis major muscle at the lateral part of the second rib[1].When the access is made through the right internal jugular vein(IJV),complications are fewer compared to cannulation of the left IJV or subclavian veins[2,3].One of the issues that is frequently encountered during catheter placement in the right IJV is the kinking of the catheter,leading to compromised or absent flow despite successful cannulation and positioning of the central venous catheter.