Extragastrointestinal stromal tumors with diffuse membranous distribution with bleeding:A case report

BACKGROUND Extragastrointestinal stromal tumors(EGIST)and gastrointestinal stromal tumors are of similar pathological type and form.Here we report a rare case of EGIST diffusely distributed in membranous tissue in abdominal cavity,the feature of which included diffuse tumors at membranous tissue in entire abdominal cavity and spontaneous bleeding of the tumors.CASE SUMMARY The patient was a 71-year man and hospitalized due to continuous pain at lower abdomen for more than 10 days.Upon physical examination,the patient had flat and tough abdomen with mild pressing pain at lower abdomen,no obvious abdominal mass was touchable,and shifting dullness was positive.Positron emission tomography-computed tomography(CT)showed that in his peritoneal cavity,there were multiple nodules of various sizes,seroperitoneum,multiple enlarged lymph nodes in abdominal/pelvic cavity and right external ilium as well as pulmonary nodules.Plain CT scanning at epigastrium/hypogastrium/pelvic cavity+enhanced three-dimensional reconstruction revealed multiple soft tissue nodules in abdominal/pelvic cavity,peritoneum and right groin.Tumor marker of carbohydrate antigen 125 was 808 U/mL,diffuse tuberous tumor was seen in abdominal/pelvic cavity during operation with hematocelia,and postoperative pathological examination confirmed EGIST.Imatinib was administered with better therapeutic effect.CONCLUSION Gene testing showed breast cancer susceptibility gene 1 interacting protein C-terminal helicase 1 and KIT genovariation,and the patient was treated with imatinib follow-up visit found that his clinical symptoms disappeared and the tumor load alleviated obviously via imageological examination.

Efficacy of percutaneous mechanical thrombus removal in acute lower extremity deep venous thrombosis

BACKGROUND Acute lower extremity deep venous thrombosis(LEDVT)is a common vascular emergency with significant morbidity risks,including post-thrombotic syndrome(PTS)and pulmonary embolism.Traditional treatments like catheter-directed thrombolysis(CDT)often result in variable success rates and complications.AIM To investigate the therapeutic efficacy of percutaneous mechanical thrombus removal in acute LEDVT.METHODS A retrospective analysis was performed to examine 58 hospitalised patients with acute LEDVT between August 2019 and August 2022.The patients were categorised into the percutaneous mechanical thrombectomy(PMT)group(n=24)and CDT group(n=32).The follow-up,safety and treatment outcomes were compared between the two groups.The main observational indexes were venous patency score,thrombus removal effect,complications,hospitalisation duration and PTS.RESULTS The venous patency score was 9.04±1.40 in the PMT group and 8.81±1.60 in the CDT group,and the thrombus clearance rate was 100%in both groups.The complication rate was 8.33%in the PMT group and 34.84%in the CDT group,and the difference was statistically significant(P<0.05).The average hospitalisation duration was 6.54±2.48 days in the PMT group and 8.14±3.56 days in the CDT group.The incidence of PTS was lower in the PMT group than in the CDT group;however,the difference was not statistically significant(P<0.05).CONCLUSION Compared with CDT,treatment of LEDVT via PMT was associated with a better thrombus clearance rate,clinical therapeutic effect and PTS prevention function,but the difference was not statistically significant.Moreover,PMT was associated with a reduced urokinase dosage,shortened hospitalisation duration and reduced incidence of complications,such as infections and small haemorrhages.These results indicate that PMT has substantial beneficial effects in the treatment of LEDVT.

Integrin beta 3-overexpressing mesenchymal stromal cells display enhanced homing and can reduce atherosclerotic plaque

BACKGROUND Umbilical cord(UC)mesenchymal stem cell(MSC)transplantation is a potential therapeutic intervention for atherosclerotic vascular disease.Integrin beta 3(ITGB3)promotes cell migration in several cell types.However,whether ITGBmodified MSCs can migrate to plaque sites in vivo and play an anti-atherosclerotic role remains unclear.AIM To investigate whether ITGB3-overexpressing MSCs(MSCs^(ITGB3))would exhibit improved homing efficacy in atherosclerosis.METHODS UC MSCs were isolated and expanded.Lentiviral vectors encoding ITGB3 or green fluorescent protein(GFP)as control were transfected into MSCs.Sixty male apolipoprotein E-/-mice were acquired from Beijing Vital River Lab Animal Technology Co.,Ltd and fed with a high-fat diet(HFD)for 12 wk to induce the formation of atherosclerotic lesions.These HFD-fed mice were randomly separated into three clusters.GFP-labeled MSCs(MSCs^(GFP))or MSCs^(ITGB3)were transplanted into the mice intravenously via the tail vein.Immunofluorescence staining,Oil red O staining,histological analyses,western blotting,enzymelinked immunosorbent assay,and quantitative real-time polymerase chain reaction were used for the analyses.RESULTS ITGB3 modified MSCs successfully differentiated into the“osteocyte”and“adipocyte”phenotypes and were characterized by positive expression(>91.3%)of CD29,CD73,and CD105 and negative expression(<1.35%)of CD34 and Human Leukocyte Antigen-DR.In a transwell assay,MSCs^(ITGB3)showed significantly faster migration than MSCsGFP.ITGB3 overexpression had no effects on MSC viability,differentiation,and secretion.Immunofluorescence staining revealed that ITGB3 overexpression substantially enhanced the homing of MSCs to plaque sites.Oil red O staining and histological analyses further confirmed the therapeutic effects of MSCs^(ITGB3),significantly reducing the plaque area.Enzyme-linked immunosorbent assay and quantitative real-time polymerase chain reaction revealed that MSC^(ITGB3)transplantation considerably decreased the inflammatory response in pathological tissues by improving the dynamic equilibrium of pro-and anti-inflammatory cytokines.CONCLUSION These results showed that ITGB3 overexpression enhanced the MSC homing ability,providing a potential approach for MSC delivery to plaque sites,thereby optimizing their therapeutic effects.

Comparative analysis of conventional ultrasound and shear wave elastography features in primary breast diffuse large B-cell lymphoma

BACKGROUND Primary breast diffuse large B-cell lymphoma(PB-DLBCL)is a rare subtype of non-Hodgkin lymphoma that accounts for<3%of extranodal lymphomas and 1%of breast tumors.Its diagnosis and management are challenging because of its rarity,heterogeneity,and aggressive behavior.Conventional ultrasound(US)is the first-line imaging modality for breast lesions;however,it has limited specificity and accuracy for PB-DLBCL.Shear wave elastography(SWE)is a novel US technique that measures tissue stiffness and may reflect the histological characteristics and biological behavior of breast lesions.AIM To compare the conventional US and SWE features of PB-DLBCL and evaluate their diagnostic performance and prognostic value.METHODS We retrospectively reviewed the clinical data and US images of 32 patients with pathologically confirmed PB-DLBCL who underwent conventional US and SWE before treatment.We analyzed conventional US features(shape,margin,orientation,echo,posterior acoustic features,calcification,and vascularity)and SWE features(mean elasticity value,standard deviation,minimum elasticity value,maximum elasticity value,and lesion-to-fat ratio)of the PB-DLBCL lesions.Using receiver operating characteristic curve analysis,we determined the optimal cutoff values and diagnostic performance of conventional US and SWE features.We also performed a survival analysis to assess the prognostic value of conventional US and SWE features.RESULTS The results showed that the PB-DLBCL lesions were mostly irregular in shape(84.4%),microlobulated or spiculated in margins(75%),parallel in orientation(65.6%),hypoechoic in echo(87.5%),and had posterior acoustic enhancement(65.6%).Calcification was rare(6.3%)and vascularity was variable(31.3%avascular,37.5%hypovascular,and 31.3%hypervascular).The mean elasticity value of PB-DLBCL lesions was significantly higher than that of benign breast lesions(113.4±46.9 kPa vs 27.8±16.4 kPa,P<0.001).The optimal cutoff value of the mean elasticity for distinguishing PB-DLBCL from benign breast lesions was 54.5 kPa,with a sensitivity of 93.8%,specificity of 92.9%,positive predictive value of 93.8%,negative predictive value of 92.9%,and accuracy of 93.3%.The mean elasticity value was also significantly correlated with Ki-67 expression level(r=0.612,P<0.001),which is a marker of tumor proliferation and aggressiveness.Survival analysis showed that patients with higher mean elasticity values(>54.5 kPa)had worse overall survival(OS)and progression-free survival(PFS)than those with lower mean elasticity values(<54.5 kPa)(P=0.038 for OS and P=0.027 for PFS).CONCLUSION Conventional US and SWE provide useful information for diagnosing and forecasting PB-DLBCL.SWE excels in distinguishing PB-DLBCL from benign breast lesions,reflects tumor proliferation and aggressiveness,and improves disease management.

Microecology-turbidity toxin theory: correlation between helicobacter pylori infection and manifestation of tongue and gastroscopy

OBJECTIVE:To clarify the relationship between helicobacter pylori(Hp)infection,tongue manifestation and gastroscopic manifestation,and explore the mechanism of action of“oral-gastric microecology”in the occurrence and development of stomach-related diseases.MEDHODS:A total of 1100 patients were divided into Hp positive group and Hp negative group according to 13 C breath test results.The tongue manifestation materials from patients were collected to make tongue printing slides for morphological observation of exfoliative cells from tongue coating,and electronic gastroscopy was performed on the patients and the data was analyzed.RESULTS:Hp infection rate was about 45.95%;and the greasy coating was mostly observed in Hp positive group(63.14%,P<0.05).The total tongue coating distribution was as follows:yellow greasy coating(56.66%,P<0.05)>yellow coating>white coating>white greasy coating.The gastric mucosal roughness and mucosal hematoplastic plaques in the two groups were more common in the Hp positive group(P<0.05).There was a significant difference in the granular subgroup and in the rough mucosal group(P<0.05).CONCLUSIONS:Hp infection is more commonly observed in yellow greasy coating,and this can be used as a reference for Traditional Chinese Medicine in determining whether it is Hp infection or not.Mucosal granule roughness,hyperemia,and oral Hp showed association with Hp infection in the stomach and interacted with micro-ecological environment that is composed of the oral cavity.